Making Sense of the Medical Transportation Universe

Transcription

1 Making Sense of the Medical Transportation Universe

2 Is North Dakota Responsible for Medical Transportation?

3 North Dakota s Great Designer

4 The American Experience MEDICAID MEDICAL TRANSPORTATION MEDICARE SOCIAL SECURITY

5 The Great Depression

6 The Two

7 The Great Depression Unemployment as high as 40 percent Farm Income and Farm Ownership The Stock Market Crash The Collapse of Wall Street Investment Firms The Dust Bowl The Collapse of International Trade The Collapse of the Nations Banking System

8 Another Voice from the Dakotas

9 NEW DEAL AMERCIA SOCIAL SECURITY

10 Back Seat Driving

11 Social Security Act 1935 Title I Old Age Assistance Title II Federal Old Age Benefit Title III Unemployment Compensation Title IV Aid to Dependent Children Title V Maternal and Child Welfare Title VI Public Health

12 Social Security Act 1935 Title VI Public Health Title VII Social Security Board Title IX Employment Taxes (Old Age Insurance) Title IX Tax on Employers of Eight or More Title X Grants to States for Aid to the Blind Title XI General Provisions

13 The Continuity of Ideas

14 THE ADVOCATE for the FAIR DEAL

15 THE OTHER TWO

16 The Persuader

17 The Great Society Finishing the New Deal The Food Stamp Program Equal Opportunity Act Older Americans Act Urban Mass Transit Act Medicare Medicaid School Breakfast Program

18 The Last Two

19 Mirror Mirror on the Wall, Who is the Greatest Reformer of them All?

20 The Greatest Reformer of them All!

21 The New Federalism Welfare Reform The Guaranteed National Income Medicare Reform SSI Revenue Sharing

22 Post New Federalism The year s since the Nixon attempt s to dramatically alter the pattern of entitlements and government programs have been all about expansion and worrying about paying for increasing demand.

23 MEDICARE The Titans and Everyone Else MEDICAID AFDC/and all the rest

24 Medical Transportation The Role of Mobility in the delivery of Medical Services like Medicaid and Medicare Reflections from a smaller planet

25 The Bang Theory

26 Theory becomes reality Demographic Changes Really Do matter Deinstitutionalization of people and programs The continual implosion of traditional health insurance The Diagnostic Reimbursement approach to rural health care providers, hospitals, and other primary care services

27 Medical Transportation As We Knew It Our friends at the funeral home The Spanish Flu Pandemic On our own Trolleys, Buses, and Trains The Taxi

28 New Delivery Systems and Paratransit Alternatives Human Service transportation especially in senior organizations and in community action agencies Accessibility in traditional public transit The Rise of Rural Public Transportation

29 The Rise of Medicaid Again deinstitutionalization Lack of Alternative Converge for Low income Seniors The Lack of Coverage for Low income Children Affordability A national crisis in infant mortality

30 Like so Many Things It s Really All About Texas

31 Texas vs. Vowell

32 What was decided? If you re a Medicaid recipient you are eligible to health care If you can t access healthcare because you have a mobility barrier your health care is denied. The State Agency responsible for your health care is responsible to get you there if you do not have a way.

33 The Results Texas was forced to provide Assurance that all Medicaid participants must have access and provide for it if they didn t Other court cases expanded this ruling to other federal judicial jurisdictions DHHS and CMS made this a requirement for state plans whether a state was covered by a decision or not. A long and hard process of benefit implementation.

34 The Bush Years

35 The Iron Triangle Deficit Reduction Act Regulations that Penalize Public Transit The Benchmark Plan Strategy

36 Blocking in the Triangle

37 Predicting The Future

38 One Alternative View

39 The Future Looks Like the Past Increased Demand for Transportation to outpatient health services Greater distances to health providers because of cost recovery pricing set by volume A greater role in publically financed health care The Continuing Aging of our society

40 Dealing with the Future Develop an Association position on Medical Transportation and its delivery. Develop an effective state strategy for dealing with state management procedures for Medicaid. Create an ongoing process of building educational support for good transportation options for people within the state, It s the quality not just the cost! Build on going communication systems between state transportation association and the state medical delivery association. Remember that the riders or users have voices as well as needs.

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